Each February, NHLBI and The Heart Truth® celebrate American Heart Month by motivating Americans to adopt healthy lifestyles to prevent heart disease. Research shows that we’re more successful at meeting personal health goals when we join forces with others1. This post “Women experience AFib more: 12 Symptoms” seeks to provide helpful information about this condition.
Atrial fibrillation, often called AFib or AF, is the most common type of treated heart arrhythmia. An arrhythmia is when the heart beats too slowly, too fast, or in an irregular way.
When a person has AFib, the normal beating in the upper chambers of the heart (the two atria) is irregular, and blood doesn’t flow as well as it should from the atria to the lower chambers of the heart (the two ventricles). AFib may happen in brief episodes, or it may be a permanent condition.
Facts About AFib
- It is estimated that between 2.7 million and 6.1 million people in the United States have AFib. As the U.S. population ages, this number is expected to increase.
- In 2017, AFib was mentioned on 166,793 death certificates and was the underlying cause of death in 26,077 of those deaths.
- People of European descent are more likely to have AFib than African Americans.
- Because the number of AFib cases increases with age and women generally live longer than men, more women than men experience AFib.
What are the symptoms of AFib2?
Some people who have AFib don’t know they have it and don’t have any symptoms. Others may experience one or more of the following symptoms:
- Irregular heartbeat
- Heart palpitations (rapid, fluttering, or pounding)
- Extreme fatigue
- Shortness of breath
- Chest pain
What are the risk factors for AFib?
The risk for AFib increases with age. High blood pressure, the risk for which also increases with advancing age, accounts for about 1 in 5 cases of AFib.
Risk factors for AFib include:
- Advancing age
- High blood pressure
- European ancestry
- Heart failure
- Ischemic heart disease
- Chronic kidney disease
- Moderate to heavy alcohol use
- Enlargement of the chambers on the left side of the heart
How is AFib related to stroke?
AFib increases a person’s risk of stroke. When standard stroke risk factors were accounted for, AFib was associated with a four- to fivefold increased risk of ischemic stroke. AFib causes about 1 in 7 strokes.
Strokes caused by complications from AFib tend to be more severe than strokes with other underlying causes. Strokes happen when blood flow to the brain is blocked by a blood clot or by fatty deposits called plaque in the blood vessel lining.
How is AFib treated?
Atrial fibrillation is treated with lifestyle changes, medicines, and procedures, including surgery, to help prevent blood clots, slow your heartbeat, or restore your heart’s normal rhythm.
Your doctor may also treat you for an underlying disorder that is raising the risk of atrial fibrillation, such as overweight or obesity, sleep apnea, or an overactive thyroid gland.
Your doctor may recommend adopting heart-healthy lifestyle changes, such as the following:
- Heart-healthy eating patterns such as the DASH eating plan, which reduces salt intake to help lower blood pressure
- Being physically active
- Getting help if you are trying to stop using street drugs
- Limiting or avoiding alcohol or other stimulants that may increase your heart rate
- Managing stress
- Quitting smoking. Visit Smoking and Your Heart and the NHLBI’s Your Guide to a Healthy Heart. Although these resources focus on heart health, they include basic information about how to quit smoking. For free help and support to quit smoking, you can call the National Cancer Institute’s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848).
- Aiming for a healthy weight to reduce the severity and number of episodes
Your doctor may consider treating your atrial fibrillation with medicines to slow your heart rate or to make your heart’s rhythm more even:
- Beta-blockers, such as metoprolol, carvedilol, and atenolol, to help slow the rate at which the heart’s lower chambers pump blood throughout the body. Rate control is important because it allows the ventricles enough time to fill with blood completely. With this approach, the abnormal heart rhythm continues, but you may feel better and have fewer symptoms. Beta-blockers are usually taken by mouth, but they may be delivered through a tube in an emergency. If the dose is too high, it can cause the heart to beat too slowly. These medicines can also make COPD and arrhythmia worse.
- Blood thinners to prevent blood clots and lower the risk of stroke. These medicines include edoxaban, dabigatran, warfarin, heparin, and clopidogrel. You may not need to take blood thinners if you are not at risk of a stroke. Blood-thinning medicines carry a risk of bleeding. Other side effects include indigestion and heart attack.
- Calcium channel blockers to control the rate at which the heart’s lower chambers pump blood throughout the body. They include diltiazem and verapamil.
- Digitalis, or digoxin, to control the rate of blood is pumped throughout the body. It should be used with caution, as its use can lead to other arrhythmias.
- Other heart rhythm medicines to slow a heart that is beating too fast or change an abnormal heart rhythm to a normal, steady rhythm. Rhythm control is an approach recommended for people who continue to have symptoms or otherwise are not getting better with rate control medicines. Rhythm control also may be used for people who have only recently started having atrial fibrillation or for highly physically active people and athletes. These medicines may be used alone or in combination with electrical cardioversion. Or your doctor may prescribe some of these medicines for you to take as needed when you feel symptoms of atrial fibrillation. Some heart rhythm medicines can make arrhythmia worse. Other side effects include effects on the liver, lung, and other organs, low blood pressure, and indigestion.
Your doctor may recommend treatments for an underlying cause or to reduce atrial fibrillation risk factors. For example, he or she may prescribe medicines to treat overweight and obesity, an overactive thyroid, lower high blood pressure, manage high blood cholesterol, control or prevent diabetes, or help you quit smoking.
Procedures or surgery
Your doctor may recommend a procedure, especially if lifestyle changes and medicine alone did not improve your symptoms. Typically, your doctor will consider a surgical procedure to treat your atrial fibrillation only if you will be having surgery to treat some other heart condition.
- Catheter ablation to destroy the tissue that is causing the arrhythmia. Ablation is not always successful and in rare cases may lead to serious complications, such as stroke. The risk that atrial fibrillation will reoccur is highest in the first few weeks after the procedure. If this happens, your doctor may repeat the procedure. In some cases, your doctor will place a pacemaker at the time of the procedure to make sure your heart beats correctly once the tissue causing problems is destroyed.
- Electrical cardioversion to restore your heart rhythm using low-energy shocks to your heart. This may be done in an emergency or if medicines have not worked.
- Pacemaker to reduce atrial fibrillation when it is triggered by a slow heartbeat. Typically, a pacemaker is used to treat atrial fibrillation only when it is diagnosed along with another arrhythmia. For example, if you are diagnosed with a slow heart rate or sick sinus syndrome, a pacemaker implanted for that condition can also prevent atrial fibrillation. If you have surgery for a pacemaker, you will need to take blood-thinning medicines.
- Plugging, closing, or cutting off the left atrial appendage to prevent clots from forming in the area and causing a stroke, if you cannot take blood thinners. Your doctor may do this at the same time as surgical ablation. It can be difficult to close off the appendage entirely, and leaking can contribute to ongoing clotting risk.
- Surgical ablation to destroy heart tissue generating faulty electrical signals. The surgeon usually does surgical ablation at the same time as surgery to repair heart valves, but in some cases, surgical ablation can be done on its own.
What are the consequences of AFib?
More than 454,000 hospitalizations with AFib as the primary diagnosis happen each year in the United States. The condition contributes to about 158,000 deaths each year. The death rate from AFib as the primary or a contributing cause of death has been rising for more than two decades.
Types of atrial fibrillation3
Paroxysmal atrial fibrillation
You may experience a brief event—a paroxysm—of atrial fibrillation. It may pass without , or you may feel it strongly. It usually stops in less than 24 hours but may last up to a week. Paroxysmal atrial fibrillation can happen repeatedly.
You may need treatment or your symptoms may go away on their own. When this kind of atrial fibrillation alternates with a heartbeat that is slower than normal, it is called tachybrady syndrome.
Persistent atrial fibrillation
Persistent atrial fibrillation is a condition in which the abnormal heart rhythm lasts for more than a week. It may ultimately stop on its own but probably will need treatment.
Long-term persistent atrial fibrillation
With this condition, the abnormal heart rhythms last for more than a year without going away.
Permanent atrial fibrillation
Sometimes atrial fibrillation does not get better, even when you have tried several times to restore a normal heart rhythm with medicines or other treatments. At this point, your atrial fibrillation is considered permanent.
If you have been diagnosed with atrial fibrillation, it is important that you continue your treatment. Follow-up care can help your doctor check your condition and talk to you about how to prevent repeat events and what to do in an emergency. Sometimes, atrial fibrillation may go back to a normal heart rhythm without treatment.
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